Multidisciplinary effort produces veteran treatment center designs

Conceptual designs for treatment centers that can be quickly constructed to serve armed forces veterans suffering from traumatic brain injuries or post-traumatic stress disorder were developed last fall in a collaborative, multidisciplinary project involving students from all four departments at the Texas A&M College of Architecture.

“Increasing numbers of veterans have returned from combat with brain injuries or PTSD, but unfortunately, only a few outpatient treatment facilities have been designed to treat these conditions,” said Susan Rodiek, associate professor of architecture and one of four faculty members who led the wide-ranging design studio project.

The treatment center proposals, three of which earned [ awards] (http://one.arch.tamu.edu/news/2013/3/8/outstanding-student-work-recognized-texas-asla/) from the Texas chapter of the American Society of Landscape Architects, were designed by students to expedite rapid deployment at rural or urban sites adjacent to existing Department of Veterans’ Affairs hospitals and clinics across the nation, said Rodiek.

Placing these centers in local communities, she said, would quickly improve veterans’ access to effective therapy without subjecting them to the expense and stress of long-distance travel away from their families, especially since these kinds of therapy regimens can last for several years.

Fast construction, cost-effective care

Each center, based on modular building units developed by [Lake|Flato Architects] (http://www.lakeflato.com/) of San Antonio, would house programs for brain injury and PTSD treatments that emphasize mental health and well-being through conventional and alternative, complementary approaches. Additionally, if not adequately provided at the adjacent VA facility, the modular units could be adapted to facilitate physical and occupational therapy, psychological counseling and family services.

The designs were developed by students in graduate and undergraduate architecture studios taught by Rodiek, and by landscape architecture students in a studio led by Chanam Lee, associate professor of landscape architecture.

The students’ research analyses and designs will be consolidated into an electronic and printed publication.

“The VA could select one of these projects as a starting point for a rapid, cost-effective avenue to improve veterans’ care,” said Rodiek.

The project yielded 14 different center designs; five developed by 22 graduate architecture and landscape architecture students grouped into five teams, and nine by two-person teams of undergraduate environmental design students.

“The modules incorporated into the student's designs are factory-built, which saves time and money, and they can be shipped within a reasonable distance,” said Rodiek. “For treatment centers built in remote locations, such as Maine or Hawaii, modules could be purchased from local fabrication plants.”

The design teams' solutions also incorporated a wide variety of site-built elements, such as porches and greenhouses, with units arranged to enclose healing gardens for outdoor therapy and relaxation. The treatment center designs used from two to eight prefabricated modules and, including site-built elements, ranged in size from 2,000 – 5,000 square feet.

Construction science students led by Ben Bigelow, visiting assistant professor of construction science, are working this spring to develop cost estimates for the student's designs.

"A modular building company in Navasota, GroundFORCE Systems, provided students with square-foot costs for the prefabricated units,” said Bigelow. “They are calculating other costs such as site-built features, landscaping, awnings and patios using a cost database adjusted to each location.”

“Cost estimating is an important aspect of this initiative, as the projects are intended to provide an innovative, cost-effective solution to a national problem,” said Rodiek.

Virtual reality therapy

Adding to the project's multidisciplinary component, two teams of visualization students led by Hwaryoung Seo, assistant professor of visualization, created therapeutic virtual reality treatment applications to aid the recovery of the centers' patients.

In a video game designed by visualization students Ivan Currey and Kevin Li, patients could work on balance and motor coordination, shifting their body weight on a 360-degree titling platform to control a spaceship traveling through an abstract universe.

The game is a low-cost alternative to the [Computer Assisted Rehabilitation Environment] (http://www.army.mil/article/28986/virtual-tech-makes-recovery-a-reality-at-walter-reed/) (CAREN) System, a state-of-the-art virtual reality rehabilitation system used at Walter Reed Army Center in Washington, D.C.

Additionally, in an augmented-reality room developed by visualization students Katherine Farley, Kevin Loney, and Thomas Storey, a patient could enter a meditative state while exploring a large space with an ultraviolet flashlight, activating geometric elements that provide emerging narratives.

“These projects represent important research into the future of rehabilitation for our wounded warriors, who in many cases must wait more than a year to receive treatment with the CAREN system,” said Seo. “Low cost alternatives like these can be installed more quickly in more places and at a fraction of the cost while maintaining much of the benefit of the full system. In addition," she said, "the aesthetic experience can make the patient's treatment session more pleasant.”

Field trips inform project research

The students’ research included field trips to military medical treatment centers in San Antonio, including tours of the Brooke Army Medical Center; the [Center for the Intrepid] (http://www.bamc.amedd.army.mil/departments/orthopaedic/cfi/) , which provides rehabilitation for troops who have sustained amputation, burns or functional limb loss; and the [Warrior and Family Support Center] (http://www.bamc.amedd.army.mil/military/wfsc/) , which provides a welcoming environment for wounded troops and their families.

They also toured the [Polytrauma Rehabilitation Center] (http://www.polytrauma.va.gov/facilities/San_Antonio.asp) , a VA facility providing intensive rehabilitative care to veterans and service members who have experienced severe injuries to more than one organ system.

“Each facility had a different ambience based on the treatments it provides,” said Rodiek.

Students also researched where the greatest concentrations of veterans suffering from head injuries and PTSD are located, the types of medical facilities available in these regions, and the average wait time for veterans seeking these kinds of treatments. Based on their findings, each team selected a different site for their project and obtained site plans of the adjacent, existing VA facility.

A lesson in collaboration

This service-learning experience, Rodiek said, offered students an opportunity to work on a wide range of design issues, from the initial research and programming, through site design, building and outdoor space design, furnishings and amenities.

“Designing a real world project made me very aware of problems that arise when choosing a site and perfecting design details,” said Sarah Stolting, an undergraduate environmental design major. “Also, working with veterans was very rewarding," she added. "I learned about things they endure on a daily basis and tried to make sure my design did not hinder, but helped their recovery.”

Dylan Kanipes, an undergraduate environmental design major, said the experience helped him to set aside his personal preferences and focus on designing for the special needs of others.

"I also learned the true power of architecture," said Kanipes, "and how it can be used to better lives.”

The semester’s work was an eye-opener for Matt Micholak, an undergraduate environmental design major, who gained appreciation, he said, for the impact veterans have on the nation and for how good architectural design can help ease the wearisome process endured by recovering veterans and their families.

Collaborating across disciplines proved both trying and rewarding for the students who honed their negotiating skills while developing an appreciation for the symbiotic relationship between landscape and building design.

“It was, honestly, hard at first, since architecture students are inclined to separate outdoor spaces into units,” said Won Min Soh, a graduate landscape architecture student. “However, in the process of negotiation, we found a good solution and are satisfied with the output.”

“I learned to incorporate the outdoors and indoors from the beginning of the design process," added Renee Lacroix, a graduate architecture student. "I learned how much of a difference developed landscape makes to the finished quality of an architecture project.”

The integration of landscape and building architecture enhances the design aesthetic while contributing to its sustainability quotient, added graduate architecture student Chris Thackrey. With sustainability an ever more prominent component of architectural design, he said, "the worlds of landscape and architecture are becoming more closely intertwined.”

Ultimately, said Rodiek, all the graduate teams were able to integrate indoor and outdoor spaces and successfully work together to create a therapeutic environment.

Expert advice

Throughout the project students were given advice and insights from an array of experts on subjects including health facility design, sacred architecture, healing gardens and health and psychiatric care for wounded soldiers. Contributing consultants included: Paul Carlton, M.D., director, Texas A&M Health Science Center Office of Innovations and Preparedness; Tom Ferris, assistant professor of industrial systems and engineering; Anat Geva, associate professor of architecture; George J. Mann professor of architecture; Naomi Sachs, Ph.D. architecture student; Lisa Whittlesey, Texas A&M AgriLife Extension Service program specialist and U.S. Army Capt.; Autumn Leveridge ’99 a health facility planner stationed in Afghanistan. Leveridge earned a Bachelor of Biomedical Engineering degree at Texas A&M.

Additionally, students received guidance from VA personnel, including Dennis Sheils, team leader of project planning and development, and Bradley Karlin, national mental health director for psychotherapy and psychogeriatrics.

Students were also advised by architecture and landscape design firms, including Lake/Flato, [SmithGroup/JJR] (http://www.smithgroupjjr.com/) , [HKS, Inc.] (http://hksinc.com/) and Quatrefoil.

The project received funding from Texas A&M as part of the university’s Action 2015: Education First Commitment, in which funds were allocated to each college to focus on high impact learning activities, and the [San Antonio A&M Club] (http://www.aggienetwork.com/clubs/findmyclub.aspx?club=8mGQm0fx9%2F1a52HKoQo73g%3D%3D) .